Basic Information
Provider Information
NPI: 1891081618
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEMSIE
FirstName: TAMERU
MiddleName: DRESSIE
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 19305
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282199305
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 600 HOSPITAL DR
Address2:  
City: MONROE
State: NC
PostalCode: 281126000
CountryCode: US
TelephoneNumber: 7049932240
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/20/2011
LastUpdateDate: 10/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X2011-01068NCN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000X2011-01068NCY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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